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Abstract
PURPOSE OF REVIEW In the last decades, three main different personality domains have been investigated in the field of eating disorders: personality traits, temperament, and personality disorders. The use of a wide range of instruments and the presence of many different approaches in the definition of personality dimensions make it difficult to summarize the emerging results from different studies. The aim of this narrative review is to critically highlight and discuss all interesting developments in this field, as reflected in the recent literature. RECENT FINDINGS The study of personality and temperament in eating disorders seems to be in line with the recently suggested dimensional approach, which highlights the importance of symptoms aggregation, rather than the categorical diagnoses. Recent literature seems to confirm that specific personality and temperamental profiles can be drawn for patients with eating disorders, which can discriminate different eating disorders' diagnoses/symptoms. SUMMARY These observations have relevant clinical implications as treatment of eating disorders is largely based on psychotherapeutic interventions. However, large longitudinal studies are needed to better clarify the suggested relationships and to identify more defined therapeutic strategies.
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Fernandez-Aranda F, Jimenez-Murcia S, Santamaría JJ, Giner-Bartolomé C, Mestre-Bach G, Granero R, Sánchez I, Agüera Z, Moussa MH, Magnenat-Thalmann N, Konstantas D, Lam T, Lucas M, Nielsen J, Lems P, Tarrega S, Menchón JM. The Use of Videogames as Complementary Therapeutic Tool for Cognitive Behavioral Therapy in Bulimia Nervosa Patients. CYBERPSYCHOLOGY BEHAVIOR AND SOCIAL NETWORKING 2015; 18:744-51. [DOI: 10.1089/cyber.2015.0265] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Fernando Fernandez-Aranda
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Susana Jimenez-Murcia
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Juan J. Santamaría
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Barcelona, Spain
| | - Cristina Giner-Bartolomé
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Barcelona, Spain
| | - Gemma Mestre-Bach
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | - Roser Granero
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Barcelona, Spain
- Departament de Psicobiologia i Metodologia, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Isabel Sánchez
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | - Zaida Agüera
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Barcelona, Spain
| | - Maher H. Moussa
- Faculty of Social Sciences and Economics, University of Geneva, Geneva, Switzerland
| | | | - Dimitri Konstantas
- Faculty of Social Sciences and Economics, University of Geneva, Geneva, Switzerland
| | | | - Mikkel Lucas
- Serious Game Interactive (SGI), Copenhagen, Denmark
| | | | | | - Salomé Tarrega
- Departament de Psicobiologia i Metodologia, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - José Manuel Menchón
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
- CIBER Salud Mental (CIBERSam), Instituto Salud Carlos III, Barcelona, Spain
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Treasure J, Zipfel S, Micali N, Wade T, Stice E, Claudino A, Schmidt U, Frank GK, Bulik CM, Wentz E. Anorexia nervosa. Nat Rev Dis Primers 2015; 1:15074. [PMID: 27189821 DOI: 10.1038/nrdp.2015.74] [Citation(s) in RCA: 178] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Anorexia nervosa (AN) is a psychiatric condition characterized by severe weight loss and secondary problems associated with malnutrition. AN predominantly develops in adolescence in the peripubertal period. Without early effective treatment, the course is protracted with physical, psychological and social morbidity and high mortality. Despite these effects, patients are noted to value the beliefs and behaviours that contribute to their illness rather than regarding them as problematic, which interferes with screening, prevention and early intervention. Involving the family to support interventions early in the course of the illness can produce sustained changes; however, those with a severe and/or protracted illness might require inpatient nursing support and/or outpatient psychotherapy. Prevention programmes aim to moderate the overvaluation of 'thinness' and body dissatisfaction as one of the proximal risk factors. The low prevalence of AN limits the ability to identify risk factors and to study the timing and sex distribution of the condition. However, genetic profiles, premorbid features, and brain structures and functions of patients with AN show similarities with other psychiatric disorders and contrast with obesity and metabolic disorders. Such studies are informing approaches to address the neuroadaptation to starvation and the other various physical and psychosocial deficits associated with AN. This Primer describes the epidemiology, diagnosis, screening and prevention, aetiology, treatment and quality of life of patients with AN.
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Affiliation(s)
- Janet Treasure
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), London SE5 8AF, UK
| | - Stephan Zipfel
- Department of Psychosomatic Medicine, University of Tuebingen, Tuebingen, Germany
| | - Nadia Micali
- University College London, Institute of Child Health, Behavioural and Brain Sciences Unit, London, UK.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Tracey Wade
- School of Psychology, Flinders University, Adelaide, Australia
| | - Eric Stice
- Oregon Research Institute, Eugene, Oregon, USA
| | - Angélica Claudino
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Ulrike Schmidt
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), London SE5 8AF, UK
| | - Guido K Frank
- Eating Disorder Centre of Denver, University of Colorado, Denver, Colorado, USA
| | - Cynthia M Bulik
- University of North Carolina at Chapel Hill, North Carolina, USA.,Karolinska Institutet, Stockholm, Sweden
| | - Elisabet Wentz
- Gillberg Neuropsychiatry Centre, University of Gothenburg, Gothenburg Sweden
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54
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Gastrointestinal symptoms and disorders in patients with eating disorders. Clin J Gastroenterol 2015; 8:255-63. [PMID: 26499370 DOI: 10.1007/s12328-015-0611-x] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 10/07/2015] [Indexed: 12/14/2022]
Abstract
The two most clinically serious eating disorders are anorexia nervosa and bulimia nervosa. A drive for thinness and fear of fatness lead patients with anorexia nervosa either to restrict their food intake or binge-eat then purge (through self-induced vomiting and/or laxative abuse) to reduce their body weight to much less than the normal range. A drive for thinness leads patients with bulimia nervosa to binge-eat then purge but fail to reduce their body weight. Patients with eating disorders present with various gastrointestinal disturbances such as postprandial fullness, abdominal distention, abdominal pain, gastric distension, and early satiety, with altered esophageal motility sometimes seen in patients with anorexia nervosa. Other common conditions noted in patients with eating disorders are postprandial distress syndrome, superior mesenteric artery syndrome, irritable bowel syndrome, and functional constipation. Binge eating may cause acute gastric dilatation and gastric perforation, while self-induced vomiting can lead to dental caries, salivary gland enlargement, gastroesophageal reflux disease, and electrolyte imbalance. Laxative abuse can cause dehydration and electrolyte imbalance. Vomiting and/or laxative abuse can cause hypokalemia, which carries a risk of fatal arrhythmia. Careful assessment and intensive treatment of patients with eating disorders is needed because gastrointestinal symptoms/disorders can progress to a critical condition.
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Wolz I, Agüera Z, Granero R, Jiménez-Murcia S, Gratz KL, Menchón JM, Fernández-Aranda F. Emotion regulation in disordered eating: Psychometric properties of the Difficulties in Emotion Regulation Scale among Spanish adults and its interrelations with personality and clinical severity. Front Psychol 2015; 6:907. [PMID: 26175710 PMCID: PMC4485313 DOI: 10.3389/fpsyg.2015.00907] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 06/16/2015] [Indexed: 01/29/2023] Open
Abstract
Objective: The aims of the study were to (1) validate the Difficulties in Emotion Regulation Scale (DERS) in a sample of Spanish adults with and without eating disorders, and (2) explore the role of emotion regulation difficulties in eating disorders (ED), including its mediating role in the relation between key personality traits and ED severity. Methods: One hundred and thirty four patients (121 female, mean age = 29 years) with anorexia nervosa (n = 30), bulimia nervosa (n = 54), binge eating (n = 20), or Other Specified Feeding or Eating Disorders (n = 30) and 74 healthy control participants (51 female, mean age = 21 years) reported on general psychopathology, ED severity, personality traits and difficulties in emotion regulation. Exploratory and confirmatory factor analyses were conducted to examine the psychometrics of the DERS in this Spanish sample (Aim 1). Additionally, to examine the role of emotion regulation difficulties in ED (Aim 2), differences in emotion regulation difficulties across eating disorder subgroups were examined and structural equation modeling was used to explore the interrelations among emotion regulation, personality traits, and eating disorder severity. Results: Results support the validity and reliability of the DERS within this Spanish adult sample and suggest that this measure has a similar factor structure in this sample as in the original sample. Moreover, emotion regulation difficulties were found to differ as a function of eating disorder subtype and to mediate the relation between two specific personality traits (i.e., high harm avoidance and low self-directedness) and ED severity. Conclusions: Personality traits of high harm avoidance and low self-directedness may increase vulnerability to ED pathology indirectly, through emotion regulation difficulties.
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Affiliation(s)
- Ines Wolz
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL Barcelona, Spain ; Ciber Fisiopatologia Obesidad y Nutrición (CIBEROBN), Instituto Salud Carlos III Barcelona, Spain ; Department of Clinical Sciences, School of Medicine, University of Barcelona Barcelona, Spain
| | - Zaida Agüera
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL Barcelona, Spain ; Ciber Fisiopatologia Obesidad y Nutrición (CIBEROBN), Instituto Salud Carlos III Barcelona, Spain
| | - Roser Granero
- Ciber Fisiopatologia Obesidad y Nutrición (CIBEROBN), Instituto Salud Carlos III Barcelona, Spain ; Department of Psychobiology and Methodology, University Autònoma of Barcelona Barcelona, Spain
| | - Susana Jiménez-Murcia
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL Barcelona, Spain ; Ciber Fisiopatologia Obesidad y Nutrición (CIBEROBN), Instituto Salud Carlos III Barcelona, Spain ; Department of Clinical Sciences, School of Medicine, University of Barcelona Barcelona, Spain
| | - Kim L Gratz
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center Jackson, MS, USA
| | - José M Menchón
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL Barcelona, Spain ; Department of Clinical Sciences, School of Medicine, University of Barcelona Barcelona, Spain ; Ciber Salud Mental (CIBERSAM), Instituto Salud Carlos III Barcelona, Spain
| | - Fernando Fernández-Aranda
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL Barcelona, Spain ; Ciber Fisiopatologia Obesidad y Nutrición (CIBEROBN), Instituto Salud Carlos III Barcelona, Spain ; Department of Clinical Sciences, School of Medicine, University of Barcelona Barcelona, Spain
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Winecoff AA, Ngo L, Moskovich A, Merwin R, Zucker N. The functional significance of shyness in anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2015; 23:327-32. [PMID: 25959923 DOI: 10.1002/erv.2363] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 03/30/2015] [Accepted: 04/01/2015] [Indexed: 11/06/2022]
Abstract
The defining features of anorexia nervosa (AN) include disordered eating and disturbance in the experience of their bodies; however, many women with AN also demonstrate higher harm avoidance (HA), lower novelty seeking, and challenges with interpersonal functioning. The current study explored whether HA and novelty seeking could explain variation in disordered eating and social functioning in healthy control women ( n = 18), weight-restored women with a history of AN (n = 17), and women currently-ill with AN (AN; n = 17). Our results indicated that clinical participants (AN + weight-restored women) reported poorer social skills than healthy control participants. Moreover, the relationship between eating disorder symptoms and social skill deficits was mediated by HA. Follow-up analyses indicated that only the 'shyness with strangers' factor of HA independently mediated this relationship. Collectively, our results suggest a better understanding of shyness in many individuals with eating disorders could inform models of interpersonal functioning in AN.
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Affiliation(s)
- Amy A Winecoff
- Department of Psychology, Bard College, Annandale-On-Hudson, NY, USA
| | - Lawrence Ngo
- Medical Scientist Training Program, Duke University School of Medicine, Durham, NC, USA.,Department of Neurobiology, Duke University School of Medicine, Durham, NC, USA
| | - Ashley Moskovich
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA.,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Rhonda Merwin
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Nancy Zucker
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA.,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
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Wildes JE, Marcus MD. Application of the Research Domain Criteria (RDoC) framework to eating disorders: emerging concepts and research. Curr Psychiatry Rep 2015; 17:30. [PMID: 25773226 DOI: 10.1007/s11920-015-0572-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The Research Domain Criteria (RDoC) project was initiated by the National Institute of Mental Health as a heuristic for addressing the limitations of categorical, symptom-based psychiatric diagnoses. RDoC is conceptualized as a matrix, with the rows representing dimensional constructs or domains implicated in the expression of psychiatric symptoms and the columns representing units of analysis that can be used to assess dimensional constructs (i.e., genes, molecules, cells, circuits, physiology, behavior, and self-reports). Few studies in eating disorders have adopted an RDoC framework, but accumulating data provide support for the relevance of RDoC dimensions to eating disorder symptoms. Herein, we review findings from RDoC-informed studies across the five domains of functioning included in the RDoC matrix-negative valence systems, positive valence systems, cognitive systems, systems for social processes, and arousal and regulatory systems-and describe directions for future research utilizing RDoC to enhance study design and treatment development in eating disorders.
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Affiliation(s)
- Jennifer E Wildes
- Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic of UPMC, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA,
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Mackenzie R. Ms X: A Promising New View of Anorexia Nervosa, Futility, and End-of-Life Decisions in a Very Recent English Case. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2015; 15:57-58. [PMID: 26147270 DOI: 10.1080/15265161.2015.1042992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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